Discursive constructions of consumer choice, performance measurement and the marketisation of disability services and aged care in Australia

O’Keeffe, Patrick; David, Christina

doi:10.1002/ajs4.139

Cited by 14 publications

(6 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the neoliberal imaginary, the mainstream service landscape is celebrated as offering an abundance of competitive choices - a marketplace of services where consumers can ‘choose with their feet’, moving between services until they find those which meet their individual preferences (O’Keefe and David, 2020). Difficulties imposed by cognitive impairment in things such as choice making, exploring services, negotiating terms of use, or participating in activities associated with services are effectively dismissed.…”

Section: Discussion: When ‘Mainstreaming’ Met ‘Choice and Control’mentioning

confidence: 99%

“…In the neoliberal imaginary, mainstream service providers are assumed to engage in competition and make adjustments to enhance inclusivity of their services to allow greater participation of people with intellectual disabilities as an untapped market opportunity of consumers (O’Keefe and David, 2020; Productivity Commission, 2011: 3). It is imagined as a buyers’ market, where mainstream service providers must actively woo and court people with intellectual disability by offering high service standards at competitive prices.…”

Section: Discussion: When ‘Mainstreaming’ Met ‘Choice and Control’mentioning

confidence: 99%

“…Yet, rather than power relations in decision making, consumer choice frameworks tend to focus on the ‘market’ dynamics in which individual choices are made, the ‘supply’ of options, and the range of personal preferences and tradeoffs that shape ‘demand’. Increasing consumers’ ability to exercise choice – i.e., to ‘choose with their feet’ by moving from one service to another - is understood as a strategy to drive improvement in the quality of services, which are then forced to become more responsive to consumers’ preferences than competitors (O’Keefe and David, 2020). Thus, consumer choice and mobility are understood as the mechanism through which spaces change from exclusive or unwelcoming to inclusive for people with disabilities.…”

Section: Choice and Controlmentioning

confidence: 99%

See 2 more Smart Citations

‘Mainstreaming’ Meets ‘Choice and Control’: Unsettling Neoliberal Imaginaries of Service Choice

Wiesel

Bigby

Holstein

et al. 2022

Environment and Planning C: Politics and Space

View full text Add to dashboard Cite

‘Mainstreaming’ and ‘Choice and control’ agendas have played a dominant role in shaping disability policy and advocacy in many countries since the 1970s, however scholarship is yet to critically explore the tensions and synergies between the two. ‘Mainstreaming’ is the aspiration to move people with disability out of ‘specialist’ spaces designed specifically for them, and into ‘mainstream’ spaces open to people of all abilities. ‘Choice and control’ concerns efforts to enhance autonomy and self-determination for people with disability. In this paper we interrogate the relationship between ‘choice and control’ and ‘mainstreaming’, both conceptually and through empirical examination of choices made by people with intellectual disability about use of mainstream services in four Australian cities. Our analysis shows their ability to choose is severely constrained by excessive control practiced by supporters, funding restrictions, affordability constraints, and exclusionary practices in mainstream services. We argue that the potential for both ‘choice and control’ and ‘mainstreaming’ has been constrained by neoliberal socio-spatial imaginaries in which they have been framed.

show abstract

Section: Discussion: When ‘Mainstreaming’ Met ‘Choice and Control’mentioning

confidence: 99%

Section: Discussion: When ‘Mainstreaming’ Met ‘Choice and Control’mentioning

confidence: 99%

Section: Choice and Controlmentioning

confidence: 99%

See 1 more Smart Citation

‘Mainstreaming’ Meets ‘Choice and Control’: Unsettling Neoliberal Imaginaries of Service Choice

Wiesel

Bigby

Holstein

et al. 2022

Environment and Planning C: Politics and Space

View full text Add to dashboard Cite

show abstract

“…This is about intended purposes, but equally important, whether there are unintended consequences. This issue has not been given much attention in research on disability services ( 5 ), but it has been explored in more depth in general studies of public governance ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

The Ambiguous Impact of Performance Measurement on Service Quality

Tøssebro

Mjøen

Bruteig

2022

Front. Rehabilit. Sci.

View full text Add to dashboard Cite

BackgroundPerformance measurement is growing in importance as a management tool in services for disabled people.AimThe aim of this article is to add to the existing literature by exploring (a) the motivation for the introduction of such measurements, (b) the reasoning behind the choice of current indicators, and (c) the impact of performance measurements on service delivery.Methods(1) A study of documents (national and, if available, also local) on the motivation for, choice of, and implementation of quality measurements, and (2) interviews with top and middle managers in community services for people with intellectual disabilities or mental health difficulties.ResultsA varied set of motivations have been identified, including the intention to introduce a more facts-based and transparent governance, the need for information that supports the management of scarce resources, and as a tool in the development of service quality for users. The motivation appears to be dependent on level of government, and the attitude among service unit managers tends to be ambivalent; they want performance measurements but cannot see how to measure the important aspects of service quality. The choice of actual indicators is subject to a process bias; that is, one measures what is easily available in administrative systems. The results concerning impact on services are less clear and also context dependent. We have identified usage in the search for cost-cutting possibilities, defense against critique, and that reporting runs the risk of reinforcing routinization of services.DiscussionThe possible impact on services is discussed. Layers of ambiguity are outlined, as measurements can be tools both for quality development and in the defense of current services against “unrealistic demands” from the media or stakeholders. The measurements tend to be used more as sources of governance information than tools for quality development.ConclusionThe impact of quality measurement is rather ambiguous. On the one hand, it functions as a tool for budget control, whereas on the other hand, unit managers call for better measurement of user outcomes and expect that such measurement can balance the current preoccupation with input indicators, such as expenditures.

show abstract

“…The marketisation of disability services is a productive environment to examine issues of workforce development, because a wide range of professional disciplines service this population in addition to an extensive largely unregistered workforce. In Australia, the health and disability sectors were relatively distinct until the recent transition to personalised funding for people with disability and aged care through the introduction of the National Disability Insurance Scheme (NDIS) and My Aged Care respectively, both legislated in 2013 [ 15 ]. Allied health professionals (AHPs) in Australia work quite differently in the different sectors.…”

Section: Introductionmentioning

confidence: 99%

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Foley

Attrill

Brebner

2021

BMC Health Serv Res

View full text Add to dashboard Cite

Background Internationally, health and social services are undergoing creative and extensive redesign to meet population demands with rationed budgets. This has critical implications for the health workforces that serve such populations. Within the workforce literature, few approaches are described that enable workforce development for health professions in the service contexts that emerge from large scale service redesign in times of industry shift. We contribute an innovative and robust methodology for workforce development that was co-designed by stakeholders in allied health during the personalisation of disability funding in Australia (the introduction of the National Disability Insurance Scheme). Methods In the context of a broad action research project, we used program logic modelling to identify and enact opportunities for sustainable allied health education and workforce integration amidst the changed service provision context. We engaged with 49 industry stakeholders across 92 research engagements that included interviews (n = 43), a workshop explicitly for model development (n = 8) and a Project Advisory Group (n = 15). Data from these activities were inductively coded, analysed, and triangulated against each other. During the program logic modelling workshop, we worked with involved stakeholders to develop a conceptual model which could be used to guide trial and evaluation of allied health education which was fit-for-purpose to emerging workforce requirements. Results Stakeholder interviews showed that drivers of workforce design during industry shift were that (1) service provision was happening in turbulent times; (2) new concerns around skills and professional engagement were unfolding for AHP in the NDIS; and (3) impacts to AHP education were being experienced. The conceptual model we co-designed directly accounted for these contextual features by highlighting five underpinning principles that should inform methodologies for workforce development and AHP education in the transforming landscape: being (1) pedagogically sound; (2) person- or family-centred; (3) NDIS compliant; (4) informed by evidence and (5) having quality for all. We use a case study to illustrate how the co-designed conceptual model stimulated agility and flexibility in workforce and service redesign. Conclusions Proactive and situated education of the emerging workforce during policy shift is essential to realise future health workforces that can appropriately and effectively service populations under a variety of changing service and funding structures – as well as their transitions. We argue that collaborative program logic modelling in partnership with key stakeholders including existing workforce can be useful for broad purposes of workforce (re)design in diverse contexts.

show abstract

Discursive constructions of consumer choice, performance measurement and the marketisation of disability services and aged care in Australia

Cited by 14 publications

References 49 publications

‘Mainstreaming’ Meets ‘Choice and Control’: Unsettling Neoliberal Imaginaries of Service Choice

‘Mainstreaming’ Meets ‘Choice and Control’: Unsettling Neoliberal Imaginaries of Service Choice

The Ambiguous Impact of Performance Measurement on Service Quality

Co-designing a methodology for workforce development during the personalisation of allied health service funding for people with disability in Australia

Contact Info

Product

Resources

About